Spine clearance

Principles

• Initially I will approach patient by ATLS protocol and I will follow BOAST 2 guideline for spine clearance.
• Immobilisation for more than 48 hrs associated with pressure sores and pulmonary complications
• incidence is 2% in conscious, 34% in unconscious
• 50% in thoracic/ lumbar

Protocol

• Protect the spine until investigations are completed and spine is cleared
• Document Neurology and clinical exam of whole spine in all at risk patient
• A cord injury mandate urgent scanning
• Unconscious/unassessable/unreliable patient needs radiological evaluation with in 48 hours
• C spine and upper dorsal: 2mm slice helical CT from base to T5 (done with head CT
• Rest: 5mm Sag & Cor slice of reformatted trauma CT series/AP & L plain radiogram
• Neurological assessment repeated regularly prior to transfer to spine unit if injury detected
• MRI is the urgent investigation of choice in SCI

Clearance without radiology

• Awake alert and not intoxicated AND
• No neck pain tenderness or neurological deficit AND
• No distracting injuries